<!DOCTYPE html>
<html>
<head>
<title>{$site_name}</title>
<meta name="keywords" content="{$site_seo_keywords}" />
<meta name="description" content="{$site_seo_description}">
<meta name="author" content="ThinkCMF">
    <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">

    <link href="__TMPL__Public/assets/css/header.css" rel="stylesheet" type="text/css"/>
    <link href="__TMPL__Public/assets/css/member.css" type="text/css" rel="stylesheet"/>
    <script type="text/javascript" src="__TMPL__Public/assets/js/jquery-1.6.1.min.js"></script>
    <script type="text/javascript" language="javascript"
            src="__TMPL__Public/assets/js/jquery.form.js"></script>
    <script type="text/javascript" src="__TMPL__Public/assets/js/formValidator-4.1.1.js"></script>
    <script type="text/javascript" src="__TMPL__Public/assets/js/formValidatorRegex.js"></script>
    <script type="text/javascript" src="__TMPL__Public/assets/js/jquery.ld.js"></script>
    <script type="text/javascript" src="__TMPL__Public/assets/js/toCash.js"></script>
    <style>
        .member .memberbox .memberL .l-title h3 a{
            _background:none;
            filter:progid:DXImageTransform.Microsoft.AlphaImageLoader(src='__TMPL__Public/assets/images/back.png', sizingMethod='crop');
        }
    </style>
</head>

<body class="body-white">
	<tc_include file="Public:nav" />


    <!--会员中心-->
    <div class="member">

        <!--所在位置-->
        <tc_include file="Public:position" />
        <!--end 所在位置-->

        <!--会员中心首页-->
        <div class="memberbox">
            <!--会员中心左边-->
            <tc_include file="Public:menu_left" />
            <!--end 会员中心左边-->

            <!--会员中心右边-->
            <div class="memberR">
                <!--余额提现-->
                <div class="r-titleTb"><h2>退货订单提现</h2></div>
                <div class="addBox">
                    <form id="cashForm" method="post">
                        <ul class="add" style=" width:1000px;">
                            <li>
                                <div class="add-r" style="margin:2px 0 0 18px;font-family: '微软雅黑';font-size: 16px;font-weight: bold">均为必填项
                                </div>
                                <div class="clear"></div>
                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px; color:#333;">退货订单编号：
                                </div>
                                <div class="info">
                                    <input id="orderNum" name="orderNum" type="text" class="input_public" style="height:25px; line-height:25px;">
                                </div>
                                <div style="float: left; margin: 0px; padding: 0px; background: none repeat scroll 0% 0% transparent; display: none;" id="orderNumTipError"><span class="onError"><span class="onError_top">请完善银行信息</span><span class="onError_bot"></span></span></div>
                                <div style="float: left; margin: 0px; padding: 0px; background: none repeat scroll 0% 0% transparent; display: none;" id="orderNumTipCorrect"><span class="onCorrect"></span></div>

                                <div class="clear"></div>
                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">申请人姓名：
                                </div>
                                <div class="info">
                                    <input id="applyUserName" name="applyUserName" type="text" class="input_public input_error" style="height: 25px; line-height: 25px; color: rgb(153, 153, 153);">
                                </div>
                                <div id="applyUserNameTip" style="float: left; margin: 0px; padding: 0px; background: transparent;"><span class="onError"><span class="onError_top">请输入字符长度2~24位的申请人姓名</span><span class="onError_bot"></span></span></div>
                                <div class="clear"></div>

                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">申请金额：
                                </div>
                                <div class="info">
                                    <input id="amount" name="amount" type="text" class="input_public" style="height:25px; line-height:25px;" readonly="true">
                                </div>
                                <div id="amountTip" style="float: left; margin: 0px; padding: 0px; background: transparent;"></div>
                                <div class="clear"></div>
                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">开户银行：
                                </div>
                                <div class="info selT">
                                    <select class="sel2" name="bankCode" id="bankCode" onchange="checkBankBase()" onblur="checkBankBase()">
                                        <option value="">请选择银行</option>
                                        <option>城市商业银行</option>
                                        <option>广东发展银行</option>
                                        <option>交通银行</option>
                                        <option>上海浦东发展银行</option>
                                        <option>深圳发展银行</option>
                                        <option>兴业银行</option>
                                        <option>邮政储汇</option>
                                        <option>招商银行</option>
                                        <option>中国工商银行</option>
                                        <option>中国光大银行</option>
                                        <option>中国建设银行</option>
                                        <option>中国民生银行</option>
                                        <option>中国农业银行</option>
                                        <option>中国银行</option>
                                        <option>中信实业银行</option>
                                    </select>
                                </div>
                                <div style="float: left; margin: 0px; background: none repeat scroll 0% 0% transparent; display: none;" id="bankCodeError"><span class="onError"><span class="onError_top" style="color: #333333">请选择银行</span><span class="onError_bot"></span></span></div>
                                <div style="float: left; margin: 0px; background: none repeat scroll 0% 0% transparent; display: none;" id="bankCodeCorrect"><span class="onCorrect"></span></div>
                                <div class="clear"></div>

                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">分行地址：
                                </div>
                                <div class="info selT">
                                    <select id="province" name="province" class="sel3" onchange="checkBank()" onblur="checkBank()">
                                        <option value="">请选择省份</option>
                                        <option value="31002" class="ld-option">北京</option><option value="31022" class="ld-option">天津</option><option value="31043" class="ld-option">河北</option><option value="31244" class="ld-option">山西</option><option value="31387" class="ld-option">内蒙古</option><option value="31516" class="ld-option">辽宁</option><option value="31649" class="ld-option">吉林</option><option value="31733" class="ld-option">黑龙江</option><option value="31892" class="ld-option">上海</option><option value="31913" class="ld-option">江苏</option><option value="32054" class="ld-option">浙江</option><option value="32170" class="ld-option">安徽</option><option value="32325" class="ld-option">福建</option><option value="32430" class="ld-option">江西</option><option value="32556" class="ld-option">山东</option><option value="32737" class="ld-option">河南</option><option value="32939" class="ld-option">湖北</option><option value="33071" class="ld-option">湖南</option><option value="33224" class="ld-option">广东</option><option value="33400" class="ld-option">广西</option><option value="33543" class="ld-option">海南</option><option value="33569" class="ld-option">重庆</option><option value="33613" class="ld-option">四川</option><option value="33839" class="ld-option">贵州</option><option value="33947" class="ld-option">云南</option><option value="34110" class="ld-option">西藏</option><option value="34199" class="ld-option">陕西</option><option value="34329" class="ld-option">甘肃</option><option value="34444" class="ld-option">青海</option><option value="34508" class="ld-option">宁夏</option><option value="34541" class="ld-option">新疆</option><option value="34669" class="ld-option">台湾</option><option value="34689" class="ld-option">香港</option><option value="34691" class="ld-option">澳门</option></select>
                                    <select id="country" name="country" class="sel3" onchange="checkBank()" onblur="checkBank()">
                                        <option value="">请选择城市</option>
                                    </select>
                                    <input id="txtbranch" name="txtbranch" style="width: 160px;" type="text" onchange="checkBank()" onblur="checkBank()" class="input_public">
                                    <input id="branchBank" name="branchBank" type="hidden">
                                </div>
                                <div style="float: left; margin: 0px; background: none repeat scroll 0% 0% transparent; display: none;padding-top:4px;" id="bankCodeTipError"><span class="onError"><span class="onError_top" style="color: #333333">请完善分行信息</span><span class="onError_bot"></span></span></div>
                                <div style="float: left; margin: 0px; background: none repeat scroll 0% 0% transparent; display: none;padding-top:4px;" id="bankCodeTipCorrect"><span class="onCorrect"></span></div>
                                <div class="clear"></div>
                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">银行用户姓名：
                                </div>
                                <div class="info">
                                    <input id="bankUserName" class="input_public" name="bankUserName" type="text" style="height:25px; line-height:25px;">
                                </div>
                                <div id="bankUserNameTip" style="float: left; margin: 0px; padding: 0px; background: transparent;"></div>
                                <div class="clear"></div>

                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">银行账号：
                                </div>
                                <div class="info">
                                    <input id="bankAccount" class="input_public" style="height:25px; line-height:25px;" name="bankAccount" type="text" maxlength="24">
                                </div>
                                <div id="bankAccountTip" style="float: left; margin: 0px; padding: 0px; background: transparent;"></div>
                                <div class="clear"></div>

                            </li>
                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">再次输入帐号：
                                </div>
                                <div class="info">
                                    <input id="bankAccount_again" class="input_public" style="height:25px; line-height:25px;" name="bankAccount_again" type="text" maxlength="24">
                                </div>
                                <div id="bankAccount_againTip" style="float: left; margin: 0px; padding: 0px; background: transparent;"></div>
                                <div class="clear"></div>
                            </li>

                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;color:#333;">申请原因：
                                </div>
                                <div class="info">
                                    <textarea class="te" id="reason" name="reason" type="text"></textarea>
                                </div>
                                <div id="reasonTip" style="float: left; margin: 0px; padding: 0px; background: transparent;"></div>
                                <div class="clear"></div>

                            </li>

                            <li>
                                <div class="lable" style="width:105px; height:25px; line-height:25px;"></div>
                                <div class="info">
                                    <div class="save"><a  href="javascript:alert('订单号不存在，请确定退货单号无误');" title="保存收货人信息">提交</a></div>
                                </div>
                                <div class="clear"></div>
                            </li>
                        </ul>
                    </form>
                </div>
                <!--end 余额提现-->


            </div>
            <!--end 会员中心右边-->
            <div class="clear"></div>
        </div>
        <!--end 会员中心首页-->
        <div class="clear"></div>
    </div>
    <!--end 会员中心-->

    <tc_include file="Public:member_footer" />

	<tc_include file="Public:footer" />

</body>
</html>